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General NPI Number Information
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NPI Number | 1508407396
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Entity Type | Organization
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Legal Business Name | GOOD LIFE COUNSELING, LLC
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Dates
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Enumeration Date | 10/02/2019
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Last Update Date | 10/02/2019
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Provider Practice Location Address
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Address Line | 1 MILL ST STE 201
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City | FARMVILLE
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State | VA
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Zip | 23901-3401
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Country | US
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Telephone | 434-207-2112
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Fax |
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Provider Business Mailing Address
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Address Line | 113 WILLIAMS ST
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City | FARMVILLE
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State | VA
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Zip | 23901-2360
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Country | US
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Telephone | 804-402-4754
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MONICA RENEE FLANAGAN
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Credential | MSW, LCSW, CSOTP
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Telephone | 804-402-4754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number |
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License Number State |
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